Too many are dying in care homes, and not just from coronavirus

The latest ONS death statistics, published yesterday, reveal a startling truth: In the week ending May 1 (week 18), there were nearly 2,000 additional deaths recorded as unrelated to Covid-19. Of those, more than three-quarters, or over 1,500, were in care homes.

This suggests that many people are dying of causes unrelated to Covid-19, but presumably connected to the lockdown (despair, stress, inaccessible medical attention, cancelled cancer treatment and so on), and that care home residents are being particularly badly affected by lockdown – perhaps by the doubling down on their isolation and consequent risk of neglect or lower standards of care.

The total number of deaths in care homes in week 18 was 6,409, which is 3,938 above the pre-epidemic figure of 2,471 in Week 11. Of these, 2,423 were recorded with Covid-19, meaning 1,515 of the additional care home deaths in Week 18, or 38.5 per cent, were not with Covid-19. That is a high proportion, and the question is what are they dying from?

Some have suggested many are likely to be unidentified Covid-19 deaths. However, equally, those registered with Covid-19 may be misattributed, or may be with, but not from, Covid-19, particularly as Covid-19 is a notifiable disease and doctors have only to suspect it to record it as a cause of death.

There have been many stories of care home deaths being put down as Covid-19 on the flimsiest of foundations, such as because there had been one unconfirmed case of Covid-19 in the home.

The ONS says it plans to publish a detailed analysis of non-Covid care home deaths at some unspecified point in the future. This will certainly be required, as what really has been going on in our care homes will be an important part of the inevitable inquiry into the Government’s handling of the coronavirus crisis.

In the year to date, just under a quarter (24.9 per cent) of all Covid-19 deaths have occurred in care homes (8,312 out of 33,391). This is very low compared to other countries, where often half or more of Covid-19 deaths are in care homes. It is unclear why England and Wales are unusual in this respect. Maybe general standards of hygiene and care, mixed though they are, are on average better than elsewhere.

Care home deaths peaked on April 17 (nine days after the overall and hospital peak on April 8) and have been declining sharply since April 26.

We are well on the way down the curve now, with 17,953 total deaths (all causes) registered in Week 18 compared with 21,997 in Week 17, and next week’s figure (for Week 19, ending May 8) should be much lower again, given what we know from the daily count.

There were 8,012 additional deaths above the five-year average in Week 18 and 6,035 that mentioned Covid-19. This means there were 1,977 excess deaths not involving Covid-19, which is 24.7 per cent. Of these, as noted, more than three-quarters, or over 1,500, were in care homes.

Which care homes were these in? Ones dedicated to dementia and multiple needs? Ones in certain geographic clusters? Ones that received high or low Care Quality Commission ratings? Ones that also suffered Covid-19 deaths? These are questions that need to be asked. It is not as though excess deaths were not predicted, given that thousands of carers and agency workers circulate between numerous care home properties, creating the perfect viral delivery system, some of whom once they realised the risks to them of no testing or PPE, did not go back to work.

Few politicians will have spent enough time in care homes to know what they are really like or how much standards vary – how many suffer from a pervasive smell of urine, how many have constant staff turnover or understaffing, or have too many staff without adequate English.

The truth is many of our active over-70s didn’t need compulsory isolating. Either they were sufficiently with it to make an intelligent choice for themselves to isolate or, if they were already vulnerably dependent, putting them totally out of sight of the rest of the population may well have further imperilled them.

Without family members visiting, who’s to know what has gone on, how well or how badly stretched care home staff have coped?

The decision by hospitals to discharge large numbers of care home residents, knowing they were infected, and return them to their care homes early on in the epidemic cannot have helped and was likely responsible for accelerating the epidemic among our most vulnerable citizens.

Increasingly it looks likely that this is not the only national scandal but that, as we predicted, when it comes to our care homes and the coronavirus, too many have died or are dying, and not just of Covid-19.

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